Around 20% of patients experience ongoing chronic pain following total knee arthroplasty (TKA), and high pain catastrophizing stands out as one of the main risk factors. Targeting this adjustable psychological factor before surgery could significantly enhance recovery. The present study compared the impact of two distinct preoperative home-based multimodal physical therapy programs on pain catastrophizing levels among TKA candidates showing high catastrophizing tendencies. A secondary aim was to monitor various postoperative results over a six-month follow-up period. Overall, 40 patients with symptomatic osteoarthritis and moderate pain catastrophizing were randomly assigned to a control group, a therapeutic patient education (TPE) group, or a multimodal physiotherapy (MPT) group. The preoperative programs involved pain neuroscience education, coping skills training, and therapeutic exercises, but differed in session volume and supervision level. Assessments occurred before and after the preoperative phase, and again at 1, 3, and 6 months after surgery. Pain catastrophizing was designated as the primary outcome.
Both treatment groups recorded notable drops in pain catastrophizing before surgery. TPE participants showed reduced resting pain and lower catastrophizing scores at 1 and 6 months postoperatively, decreased kinesiophobia and improved dynamic balance at 3 and 6 months, and elevated self-efficacy at 1 month. In contrast, MPT participants demonstrated lower catastrophizing. They reduced pain while walking at 1 month post-surgery, along with improvements in kinesiophobia, self-efficacy, and dynamic balance across 1, 3, and 6 months, plus increased walking speed by 6 months postoperatively. Preoperative physiotherapy successfully decreases pain catastrophizing before surgery and leads to better pain-related outcomes, psychological adjustments, and functional behaviors in high-catastrophizing TKA patients during the recovery phase. The trial is registered with the United States Clinical Trials Registry (NCT03847324).
